Thursday, April 30, 2015
It’s critical to understand the role that cholesterol plays in heart disease, because we have been egregiously misled in this area by conventional wisdom. Physicians and patients in general have a severely distorted view of the true mechanisms and risk factors for heart disease. We harbor the oversimplified beliefs that LDL causes heart disease (so you shouldn’t eat cholesterol-containing foods) and that if your LDL cholesterol is too high you should take statin medications to lower it.
Nothing could be further from the truth! This article will present a complete and easily understandable picture of cholesterol’s role in the body and the true risk factors for heart disease.
A cholesterol panel is the most over hyped, misinterpreted, misunderstood, and misleading lab test I deal with in my clinic. As a result of the cholesterol fixation, we now have a population that is grossly over treated with statin medications and under treated with proper lifestyle changes. Statins are so incredibly effective at treating high cholesterol numbers within a few weeks, that many patients, feeling falsely protected by these drugs, continue their downward trend of unhealthy habits.
How protected are you when you take a medication to control your cholesterol without making healthy lifestyle changes? Not very! A UCLA study found that 75 percent of patients hospitalized for a heart attack had an LDL within the acceptable range of less than 130 mg/dl, and half had levels of less than 100 mg/dl, which is considered ideal. These results seem to indicate that we’ve gotten very good at treating numbers without treating the underlying causes —insulin resistance and inflammation!
Fortunately, the new 2013 cholesterol guidelines, drafted by the ACC/AHA (American College of Cardiology and American Heart Association) discourage treating with statins to achieve specific LDL target numbers. This faulty approach has led to millions of statin users taking higher than normal statin doses or multiple cholesterol medications in an attempt to achieve goal LDL numbers.
Medications like Zetia have helped patients reach goal LDL numbers, but they have never been proven to reduce the incidence of heart disease, the real goal. The new guidelines finally acknowledge the safety concerns of statin use, but unfortunately recommend the use of an inaccurate risk calculator tool to assess the need for statins. Dr. Nancy Cook and Dr. Paul M. Ridker of Harvard Medical School conducted a rigorous analysis of more than 100,000 healthy patients and found that this risk calculator tool overestimated heart attack and stroke risk by 75 to 150 percent. They stated in a commentary published in the prestigious journal The Lancet:
“It is possible that as many as 40 to 50 percent of the 33 million middle-aged Americans targeted by the new guidelines for statin therapy do not actually have risk thresholds exceeding the 7.5 percent level suggested for treatment.”
In addition to overestimating risk, this calculator also underestimates risk in South Asians by ignoring key markers such as high triglycerides, prediabetic blood sugar levels, and abdominal obesity. I’ve personally used this tool in South Asian patients who have had a heart attack and it frequently predicts a very low risk! If doctors use this tool, they will be telling many insulin resistant patients they have nothing to worry about, when in fact they are actually ticking time bombs.
Unfortunately, the calculator is based on outdated studies featuring predominantly Caucasian patients.
Rather than relying on this imprecise tool, you can accurately interpret your numbers using the six cholesterol rules (discussed later, as well as the Metabolic 6-pack.
· 1. Trim your waist circumference to less than 90 cm (35 inches) in males and 80 cm (31 inches) in females
· 3. Raise your HDL cholesterol above 40 mg/dL (1.03 mmol/L) if you’re male and above 50 mg/dL (1.29 mmol/L) if you’re female
· 4. Reduce systolic BP (top number) at or below 120 and diastolic BP (bottom number) at or below 80 mm Hg